Download 1. Significant Exposure or Injury in a Clinical Setting

1. Significant Exposure or Injury in a Clinical Setting
Significant Exposure or Injury in a Clinical/Lab Setting:
An exposure can be defined as a percutaneous injury (e.g., needlestick or cut with a sharp object)
or contact of mucous membrane or nonintact skin (e.g., exposed skin that is chapped, abraded, or
with dermatitis) with blood, saliva, tissue, or other body fluids that are potentially infectious.
Exposure incidents might place health care personnel at risk for hepatitis B virus (HBV),
hepatitis C virus (HCV), or human immunodeficiency virus (HIV) infection, and therefore
should be evaluated immediately following treatment of the exposure site by a qualified health
care professional.
(Centers for Disease Control and Prevention)
The following is a recommended approach for student reporting and instructor action should
a significant exposure or injury occur during a clinical setting.
1. Student shall notify Clinical/Lab instructor.
2. Clinical instructor to notify Infection Control Nurse (exposures only)
3. Student proceeds to facility’s Emergency Department, signs in as a patient for
treatment. If off site, the student should go to nearest hospital emergency
department.
4. Clinical/Lab instructor to notify the Clinical Coordinator / Program Manager via
Voice Mail. 868-3418.
5. Clinical/Lab instructor to call Palm Beach State College Security for an
incident report to be completed. 561-868-3600, day or night.
6. Clinical Coordinator/Program Manager notifies Safety and Security 868-3487.
7. (Optional) Clinical instructor to call or page Dr. Landman for student counseling
and follow up care for exposures only. 561-969-7900, day or night.
8. Student shall send a detailed e-mail to Clinical Coordinator / Program Manager
regarding incident specifics.
9. Clinical instructor to provide a copy of the insurance form to emergency
registration upon student registration.
2. Physician Notification of Significant Exposure
Palm Beach State College
Physician Notification of Significant Exposure
To:
Emergency Room Physician
From:
Dr. Ken Scheppke, MD
Subject: Significant Exposure to Bloodborne Pathogens
The student before you has sustained a significant exposure to a potentially infectious body fluid
during the course of medical treatment of ________________________________________
(patient name)
Per Florida State Statute 381.004(10), this medical personnel (student) has the right to know the
HIV status of this source patient. Florida law allows you to perform a HIV test on this patient
either with their consent or without their consent if blood specimens have been obtained for other
purposes.
In addition, it is not mandated by the state but if the source patient consents, we are also
requesting a Hepatitis B and C test be performed.
Please have your staff contact the hospitals Infection Control Coordinator and advise them of the
incident. They will forward the results to Palm Beach State College, 4200 Congress Avenue,
Risk Management Department, Lake Worth Florida, 33461. Thank you for your cooperation.
Ken Scheppke, MD
Medical Director
Palm Beach State College EMS Programs
Student Name ____________________________________________ Date ____________
Student Signature ___________________________________________________________
Blood specimen obtained from source patient (check one)
Source patient HIV testing (per state statute 381.004)
Refused
□Yes
□ With consent
□No
□ Without consent □
3. Declination of Post-Exposure Evaluation
PALM BEACH STATE COLLEGE
EMS PROGRAMS
DECLINATION OF POST-EXPOSURE EVALUATION
On___________________, I experienced an incident while participating in a Palm Beach State
College EMS Program, which may have caused my exposure to bloodborne pathogens. An
Accident-Incident Report was filed at that time.
I have been advised that I may be evaluated by a physician pursuant to this incident, which may
include serologic testing for HIV and HBV, and that there will be no cost to me for this
evaluation. However, I choose to decline having the evaluation performed, with the
understanding that I may have blood drawn at this time but not tested until a later time of my
choosing (up to 90 days following the date of the incident).
_________________________________________
Printed Name
_________________________________________
Signature
________________________________________
Date